Objective To study the effects of different pellet feed hardness on the growth and reproduction,feed utilization rate,and environmental dust in laboratory mice.Methods One hundred of fifty 50 3-week-old SPF-grade C57BL/6JGpt and 150 ICR laboratory mice were randomly divided into three groups,with an equal number of males and females.They were fed diets with different hardness of 18.62 kg,23.15 kg,and 27.89 kg.Body weight,feed utilization rate,and dust levels in cages were recorded and calculated for mice aged 3-10 weeks.Forty-five 6-week-old male mice and ninety 4-week-old female mice from each strain were randomly divided into three groups and fed pellet feeds with three different hardness levels.After 2 weeks of adaptation to the same hardness feed,the mice were paired at a 1:2 male-to-female ratio and monitored for reproductive data for 3 months.Results At the age of 4 weeks,the body weight of male C57BL/6JGpt mice in 23.15 kg group was significantly higher than that in the 18.62 kg and 27.89 kg groups(P＜0.01),and the body weight of females in the 18.62 kg group was significantly higher than that in the 27.89 kg group(P＜0.05).There was no significant difference in body weight among ICR mice aged 3-10 weeks across different feed hardness groups(P＞0.05).For both strains,feed utilization rate for males was higher than that for females across different feed hardness groups at all weeks of age(P＜0.01).Compared to the 27.89 kg group,both the 18.62 kg and 23.15 kg groups showed a significant increase in the 50-mesh dust levels in cages for both strains aged 4-8 weeks(except for 7-week-old C57BL/6JGpt mice)(P＜0.05).For both C57BL/6JGpt and ICR mice,there was no significant difference in basic reproductive performance such as interval between the first litter and the monthly production index among the three feed hardness groups during the experimental period(P＞0.05).However,the monthly production index of C57BL/6JGpt mice first increased and then decreased with the increase of feed hardness,while that of ICR mice increased with increasing feed hardness,though these differences were not statistically significant(P＞0.05).Conclusion Different strains and genders had different tolerance to feed hardness.C57BL/6JGpt mice are more adapted to lower hardness feeds,while ICR mice are better suited to slightly higher hardness feeds.

Objective:To predict the risk of cryptogenic stroke (CS) patients with right-to-left shunt (RLS) by machine learning, and provide potential solutions for accurate and efficient prediction of CS.Methods:A retrospective analysis of clinical data on 289 subjects with positive RLS detected by contrast-enhanced transcranial Doppler tests (c-TCD) treated in the Department of Neurology at Laoshan Campus, the Affiliated Hospital of Qingdao University, from January 2018 to September 2023, including demographic information, medical history, laboratory test indicators, diagnosis, and treatment.The dataset was randomly divided into a training set and a testing set by the machine learning function train_test_split(), with a ratio of 8∶2.Risk prediction models for CS in RLS subjects were constructed by algorithms such as Logistic regression, decision trees, random forests, extreme gradient boosting, artificial neural networks, gradient boosting, extra trees, and adaptive Boosting.The model performance was evaluated by receiver operating characteristic curves (ROC), area under curve (AUC), confusion matrix, precision, recall, accuracy, F1 score, calibration curves, and decision curve analysis.The optimal model was subjected to interpretability analysis by feature importance and SHAP values.The t-test, Mann-Whitney U test and χ2 test were used for data analysis by SPSS 25.0 software.Delong test was used to compare the differences in AUC between the two models. Results:In 289 RLS subjects, there were 166 cases of CS (57.5%) and 123 cases of non-CS (42.5%).The statistical analysis results showed that blood biochemical indicators such as D-dimer, mean platelet volume, and fibrinogen in CS patients were higher than those in non-CS patients (all P<0.01).There were no statistically significant differences in variables between the training and testing sets(all P>0.05).Random forest model achieved the highest AUC (0.885), precision (0.806), recall (0.879), accuracy (0.810), and F1 score (0.841) for CS risk prediction in the testing set.The calibration curve showed that the random forest model was closest to the reference line, and the decision curve analysis indicated that it had a greater net benefit.The interpretability analysis revealed that high-risk factors included mean platelet volume, D-dimer, international normalized ratio, body mass index, and age. Conclusion:The random forest-based prediction tool exhibits excellent performance, demonstrating high accuracy in predicting CS risk in RLS population.

To analyze the correlation between the duration of hyperbaric oxygen (HBO) therapy and oral medication clonazepam reduction in patients with paroxysmal sympathetic hyperactivity (PSH).

Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.Methods Based on evidence summaries and expert consultation,a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed,consisting of 19 items covering 7 aspects including identification of risk factors,position management,tube and cuff selection,cuff management,mechanical ventilation management,pain and sedation management,removal of oropharyngeal and subglottic secretions,and oral care.Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June,2022 to September,2023.Patients were divided into an experimental group(n=72)and a control group(n=69)according to the wards.The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.The control group received the nursing bundle for ventilator associated pneumonia(VAP).The incidence and time from intubation to microaspiration and VAP,duration of mechanical ventilation,ICU length of stay,and disease outcome were compared between the 2 groups.Results The incidence of microaspiration of oropharyngeal secretions,the duration of mechanical ventilation,time from intubation to microaspiration showed significant differences between the 2 groups(P<0.05).There were no significant differences in the incidence of ventilator associated pneumonia,ICU length of stay,and disease outcome between the 2 groups(P>0.05).The time from intubation to VAP in the experimental group was 7.5 days,and that in the control group was 3.8 days.Conclusion The application of the management plan for microaspiration of orophaiyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration,delaying the time from intubation to microaspiration and VAP,and shortening the duration of mechanical ventilation.

OBJECTIVE To investigate the effects of Codonopsis pilosula polysaccharide （CPP） regulating the nuclear factor- erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway on gastric mucosal injury in rats with chronic atrophic gastritis （CAG）. METHODS Rats were randomly divided into control group， model group， CPP low-dose， medium-dose and high-dose groups （CPP 10， 20， 40 mg/kg）， and ML385 group （Nrf2 inhibitor ML385 30 mg/kg+CPP 40 mg/kg）， 10 rats per group. CAG rat model was established using N-methyl-N′- nitro-N-nitrosoguanidine combined with irregular diet， then they were given drugs for consecutive 6 weeks. HE staining was used to observe the pathological changes in gastric tissue morphology； the levels of serum gastrin （GAS）， motilin （MTL）， pepsin （PP）， as well as tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8） malondialdehyde （MDA） and superoxide dismutase （SOD） in gastric mucosal tissue were detected； TUNEL assay was used to observe gastric mucosal tissue cell apoptosis； immunohistochemical assay was adopted to observe the expressions of Nrf2 and recombinant Bcl2 associated X protein （Bax） in gastric mucosal tissue； Western blot was used to detect the expressions of Nrf2， HO-1， Bax and Bcl-2 proteins in gastric mucosal tissue. RESULTS Compared with the control group， the gastric mucosal tissue was damaged； the levels of GAS， MTL， PP and SOD， and the protein expressions of Nrf2， HO-1 and Bcl-2 were significantly reduced in model group （P＜0.05）， while the levels of MDA， TNF-α and IL-8， the cell apoptosis index， and the protein expression of Bax were significantly increased （P＜0.05）. Compared with model group， CPP low-dose， medium-dose and high- dose groups showed varying degrees of improvement in gastric mucosal histopathology； the levels of the quantitative indicators were significantly reversed （P＜0.05）. Nrf2 inhibitor ML385 significantly attenuated the improvement effect of high-dose CPP on the above indicators in CAG rats （P＜0.05）. CONCLUSIONS CPP can improve gastric mucosal injury in CAG rats， and inhibit oxidative stress， inflammatory response， and cell apoptosis. The mechanism of action may be related to the activation of Nrf2/HO-1 signaling pathway.

Objective:To explore the incidence of thirst in patients undergoing pancreaticoduodenectomy and analyze its influencing factors.Methods:From March to October 2022, 155 patients with pancreaticoduodenectomy admitted to the First Medical Center of the Chinese People's Liberation Army General Hospital were selected as the study subject by convenience sampling. The patients were surveyed using the self-made general information questionnaire, Thirst Numerical Rate Scale, oral mucosal misture score, Self-Rating Anxiety Scale, and Self-Rating Depression Scale to understand the incidence of thirst and analyze influencing factors.Results:A total of 153 valid questionnaires were collected, with a valid response rate of 98.71%. Among them, 124 patients (81.05%) experienced postoperative thirst. Univariate analysis showed that there were statistical differences in the incidence of thirst among patients with different ages, fasting time, smoking history, drinking history, hypertension history, diabetes history, anxiety and depression ( P<0.05). Logistic regression analysis showed that age, hypertension history, diabetes history, anxiety and depression were the main influencing factors for thirst in patients undergoing pancreaticoduodenectomy ( P<0.05) . Conclusions:Thirst is common in patients after pancreaticoduodenectomy. Age, hypertension history, diabetes history, anxiety and depression are the influencing factors of thirst in patients after pancreaticoduodenectomy. Medical and nursing staff should provide targeted interventions for thirst prevention and treatment based on relevant factors.

Objective:To compare the clinical effects of minimally invasive vitreous surgery with and without anti-vascular endothelial growth factor (VEGF) drugs for polypoid choroidal vascular disease (PCV) complicated with vitreous hemorrhage.Methods:A cohort study was performed.Thirty-six consecutive cases (36 eyes) with PCV combined with vitreous hemorrhage who underwent 25G minimally invasive vitreous surgery in Xuzhou First People's Hospital from June 2015 to June 2020 were enrolled.According to surgical methods, the patients were divided into pars plana vitrectomy (PPV) group (24 eyes) receiving vitrectomy only and PPV+ anti-VEGF group (12 eyes) receiving vitrectomy first and intravitreal injection of anti-VEGF drugs one week after the operation.All patients were followed up for at least 6 months.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) of the two groups before treatment, 1 month after treatment and at the last follow-up were measured and compared.Postoperative complications such as recurrence of vitreous hemorrhage and macular scar formation were recorded.This study followed the Declaration of Helsinki and was reviewed and approved by the Medical Ethics Committee of Xuzhou First People's Hospital (No.xyyll[2021]014).Written informed consent was obtained from each patient before surgery.Results:Statistically significant differences were found in BCVA between the two groups before and after treatment ( Fgroup=8.552, P=0.006; Ftime=31.775, P<0.001).The BCVA of the two groups at 1 month after operation and at the last follow-up were significantly improved in comparison with before treatment, and the BCVA at the last follow-up was significantly better than that at 1 month after operation (all at P<0.05).One month after operation and at the last follow-up, the BCVA of PPV+ anti-VEGF group was better than that of PPV group, showing statistically significant differences (both at P<0.05).Statistically significant differences were found in CRT between the two groups before and after treatment ( Fgroup=4.797, P=0.041; Ftime=295.764, P<0.001).One month after operation and at the last follow-up, the CRT of both groups was significantly improved in comparison with before treatment, and the CRT was significantly better at the last follow-up than 1 month after operation (both at P<0.05).The postoperative 1-month CRT of PPV+ anti-VEGF treatment group was lower than that of PPV group, with statistically significant difference ( P<0.05).No statistically significant difference was found in CRT between the two groups at the last follow-up ( P>0.05).Elevated intraocular pressure occurred in 2 eyes and rhegmatogenous retinal detachment in 1 eye in PPV group, accounting for 8.33% and 4.17%, respectively.Cataract aggravated in 2 eyes in PPV+ anti-VEGF group.The incidence of vitreous rebleeding in PPV group and PPV+ anti-VEGF group was 16.67%(4/24) and 8.33%(1/12), respectively, with no significant difference ( P=0.646).The incidence of macular scarring in PPV group and PPV+ anti-VEGF group was 4.17%(1/24) and 33.3%(4/12), respectively, showing a statistically significant difference ( P=0.030). Conclusions:Minimally invasive vitreous surgery is a safe and effective way to treat PCV combined with vitreous hemorrhage.It can improve vision, reduce CRT, and the effect is gradually enhanced in the short term.Intravitreal injection of anti-VEGF drugs can enhance the postoperative effect of PPV and present better vision and anatomical structure of retina.

Objective:To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods:A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020. The general information, exposure time, poisoning dose, poisoning cause, poisoning route, clinical manifestations, laboratory examination results during hospitalization, treatment measures, hospital stays and prognosis of the patients were collected. The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016. The highest severity score during hospitalization was used as the final grade. According to the final grade, asymptomatic and mild patients were included in the mild group, and moderate, severe and death patients were included in the severe group. The independent sample T test or Mann-Whitney U test was used for measurement data, and χ2 test or Fisher's exact test was used for counting data. The differences of general data and clinical data between the two groups were compared. Results:According to the inclusion and exclusion criteria, 83 patients with acute glyphosate herbicide poisoning were selected as the study subjects. All patients survived, mainly mild poisoning (56.6%), with a male to female ratio of 33∶50, and an average age of 39 years. The number of poisoning cases increased yearly (the highest in 2019), and most cases occurred in spring and summer. The main cause of poisoning was suicide (71.1%), direct oral administration (83.1%) was the primary route of poisoning, and the dominating clinical manifestations were digestive symptoms (71.1%). Laboratory tests showed increased white blood cell count (WBC), neutrophil percentage (NEUT %) and D-dimer, and decreased hemoglobin and potassium. Compared with the mild group, patients in the severe group were older [(51±17) years vs. (35±19) years], had a higher proportion of suicide and direct oral administration, a longer hospital stay [8.0 (4.8, 12.0) d vs. 3.0 (2.0, 5.5) d], a higher dose of poisoning [200.0 (50.0, 200.0) mL vs. 30.0 (11.3, 57.5) mL], and higher NEUT % within 24 h of admission [(83.4±10.4) vs. (73.2±12.8)]. The increase of WBC, NEUT %, aspartate aminotransferase, prothrombin time, D-dimer and the decrease of serum potassium were more common in the severe group than the mild group, with statistical significance (all P<0.05). Conclusions:The number of patients with acute glyphosate herbicide poisoning is increasing yearly. Generally, the condition is mild and the prognosis is satisfying. The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration, high toxic dose, and high NEUT % within 24 h of admission. Severe poisoning is more likely to cause changes in laboratory indicators.

Objective　To explore independent risk factors for early neurological deterioration in first-ever minor ischemic stroke without reperfusion therapy,and to achieve individualized prediction by constructing a nomogram model.Methods　We enrolled first-ever minor ischemic stroke patients of non-reperfusion therapy from January 1,2017 to December 31,2019 in the Zhaoqing First People’s Hospital.The clinical and imaging data of the Neurological deterioration group(END group) and the non-END group were analyzed.The independent related factors were screened and the nomogram model was constructed.Results　A total of 384 cases were enrolled,including 66 cases (17.19%) in the END group and 318 cases (82.81%) in the non-END group.Logistic regression analysis showed that diabetes mellitus,TOAST typing,albumin levels,and cerebral atherosclerosis score (CAS) were independent influencing factors (P<0.05).The nomogram model is constructed and the ROC curve is generated,and the area under the curve is 0.859［95%CI(0.758,0.864)］.Model consistency can be hinted at by the calibration curve and the Hoster-Lemeshow test.Finally,the clinical decision curve indicates that the model has clinical application value.Conclusion　This study explores the nomogram model for END in first-ever minor ischemic stroke without reperfusion therapy,which has some clinical application value,is composed of four major factors:diabetes mellitus,TOAST typing,albumin level and CAS.

Objective:To compare the protective effect of corneal protectant hydroxypropyl methylcellulose (HPMC) and balanced salt solution (BSS) on corneal epithelium in vitreous body surgery for proliferative diabetic retinopathy (PDR).Methods:A randomized controlled clinical trial was conducted.Fifty eyes of 50 patients with PDR who underwent minimally invasive vitrectomy in Xuzhou First People's Hospital from September 2018 to January 2019 were enrolled and randomly divided into HPMC group and BSS group, with 25 eyes in each group.All eyes underwent three-channel minimally invasive vitrectomy under non-contact wide-angle lens, and 2% HPMC and BSS were applied to keep the ocular surface moist according to grouping during the operation.The combination of cataract surgery, operation time, application times of 2% HPMC or BSS and the grade of corneal epithelial edema before and after operation were recorded.The patients were followed up for 1 month.Corneal fluorescein sodium staining and tear film break-up time (BUT) test were performed before operation and at 1 day, 3 days, 10 days and 1 month after operation.Schirmer Ⅰ test (SⅠt) and ocular surface disease index (OSDI) questionnaire were carried out before operation and at 1 month after operation.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Xuzhou First People's Hospital (No.xyyⅡ[2018]005). Written informed consent was obtained from each patient prior to any medical examination.Results:The average frequency of application of eye drops in the HPMC group was (5.00±1.56) times, which was significantly less than (50.56±17.00) times in the BSS group ( t=-13.071, P<0.01). The postoperative corneal edema score of the HPMC group was 1.0 (1.0, 1.0) point, which was lower than 2.0 (2.0, 2.0) points of BSS group, and the difference was statistically significant ( Z=-4.909, P<0.01). There were statistically significant differences in postoperative corneal fluorescein sodium scores among 1 day, 3 days, 10 days and 1 month in the two groups (HPMC group: χ2=36.040, P<0.01; BSS group: χ2=50.892, P<0.01). The 1-, 3- and 10-day postoperative corneal fluorescein sodium scores in the HPMC group were significantly lower than those in the BSS group (all at P<0.05). One-day, 3-day, 10-day and 1-month postoperative BUT values were (6.15±2.20), (6.95±2.46), (6.16±2.11) and (5.81±2.92) seconds in the HPMC group, respectively, and were (3.89±1.87), (5.32±2.59), (5.01±2.12) and (4.97±2.10) seconds in the BSS group, respectively.There were significant differences in BUT between the two groups at different time points ( Fgroup=5.240, P<0.05; Ftime=2.846, P<0.05). The preoperative and 1-month postoperative SⅠt values in the BSS group were (12.24±5.55)mm and (9.96±4.53)mm, respectively, showing a statistically significant difference ( t=3.863, P=0.001). The postoperative OSDI score in the BSS group was (51.00±12.04) points, which was significantly higherly than the preoperative value of (47.89±10.95) points, and the difference was statistically significant ( t=-2.111, P<0.05). Conclusions:Compared with BSS, 2% HPMC in minimally invasive vitreous surgery has better protective effect on corneal epithelium of PDR, reduces the frequency of eye drop use during the surgery and shortens the repair time of ocular surface tissue after surgery.